Background
Methods
Data collection
Hygiene routines before intervention
Preoperatively
Intraoperatively
Postoperatively
Changes in hygiene routines after intervention
Preoperatively
Intraoperatively
Postoperatively
General attitudes
Statistics
Ethics, consent and permissions
Results
Patient demographics
2006–2012 | |||
---|---|---|---|
Review of patient medical records (n = 503) | No review of patient medical records (n = 1139) |
p
| |
Age (years) | 67 ± 9 | 67 ± 9 | 0.907 |
Sex M/F | 410/93 | 923/241 | 0.874 |
Identification of risk factors associated with sternal wound infection in the cohort
Patients without infection (n = 455) | Patients with infections (n = 48) |
p-value | |
---|---|---|---|
Patient related riskfactors | |||
Age (years) | 67 ± 9 | 65 ± 10 |
0.053
|
Sex M/F | 374/81 | 36/12 |
0.222
|
Body mass index (kg/m2) | 28 ± 4 | 28 ± 4 |
0.954
|
Preoperative insulin-like growth factor 1 (mmol/mol) | 45 ± 11 (n = 438) | 51 ± 17 (n = 46) |
0.070
|
Diabetes (%) | 119/455 (26.5 %) | 20/48 (41.7 %) |
0.022 (*)
|
Preoperative hemoglobin concentrations (g/L) | 141 ± 14 (451) | 137 ± 11 (n = 47) |
0.086
|
Preoperative serum creatinine concentrations (μg/L) | 86 ± 28 (n = 452) | 85 ± 23 (n = 47) |
0.597
|
Corticoid steroid treatment (%) | 12/455 (2.6 %) | 2/48 (4.2 %) |
0.540
|
Current smoking no/smoked the last 2 months/never smoked | 54/314/87 | 7/36/5 |
0.319
|
Chronic Obstructive Pulmonary Disease (%) | 12/455 (2.6 %) | 1/48 (2.1 %) |
0.818
|
Ejection fraction (%) | 48 ± 9 (n = 348) | 49 ± 10 (n = 35) |
0.272
|
Intraoperative risk factors | |||
Number of saphenous vein grafts (n) | 3 ± 1 (n = 424) | 3 ± 1 |
0.693
|
Internal mammary artery 0/1/2 | 41/412/2 | 2/46/0 |
0.621
|
Duration of cardiopulmonary by-pass time (min) | 85 ± 29 (n = 453) | 85 ± 27 |
0.683
|
Duration of aortic cross clamp time (min) | 47 ± 19 (n = 453) | 49 ± 19 |
0.634
|
Postoperative risk factors | |||
Erythrocyte transfusion day 0 (%) | 135/455 (29.7 %) | 19/48 (39.6 %) |
0.156
|
Erythrocyte transfusion day 1 (%) | 71/455 (15.6 %) | 10/48 (20.1 %) |
0.349
|
Erythrocyte transfusion day 2 (%) | 65/455 (14.3 %) | 14/48 (29.2 %) |
0.007 (**)
|
Mean blood glucose concentration day 0 (mmol/L) | 7.8 ± 1.3 (n = 453) | 7.5 ± 1.0 |
0.295
|
Mean blood glucose concentration day 1 (mmol/L) | 8.2 ± 1.6 (n = 453) | 8.5 ± 1.8 |
0.213
|
Mean blood glucose concentration day 2 (mmol/L) | 9.0 ± 2.2 (n = 380) | 9.4 ± 3.0 (n = 46) |
0.788
|
Patient profiles in period one compared to period two
2006–2010 to week 26 (Period 1) | 2010 from week 27–2012 (Period 2) |
p-value | |
---|---|---|---|
n = 362 |
n = 141 | ||
Patient related riskfactors | |||
Age (years) | 67 ± 9 | 67 ± 9 |
0.610
|
Sex M/F | 73/289 | 121/20 |
0.121
|
Body mass index (kg/m2) | 28 ± 4 | 28 ± 4 |
0.998
|
Preoperative insulin-like growth factor 1 (mmol/mol) | 46 ± 12 | 44 ± 11 |
0.014 (*)
|
Diabetes (%) | 94/268 (26 %) | 45/96 (32 %) |
0.180
|
Preoperative hemoglobin concentrations (g/L) | 140 ± 14 | 141 ± 14 |
0.880
|
Preoperative serum creatinine concentrations (μg/L) | 86 ± 28 | 87 ± 38 |
0.747
|
Chronic obstructive pulmonary disease (%) | 12/350 (3.3 %) | 1/140 (0.7 %) |
0.098
|
Corticoid steroid treatment (%) | 6/356 (1.7 %) | 8/133 (5.7 %) |
0.014 (*)
|
Current smoking/smoked the last 2 months/never smoked | 46/246/70 | 15/104/22 |
0.444
|
Ejection fraction (%) | 48 ± 9 | 49 ± 8 |
0.041 (*)
|
Intraoperative risk factors | |||
Number of saphenous vein grafts (n) | 3 ± 1 | 3 ± 1 |
0.982
|
Internal mammary artery 0/1/2 | 30/330/2 | 13/128/0 |
0.646
|
Duration of cardiopulmonary by-pass time (min) | 85 ± 28 | 85 ± 29 |
0.744
|
Duration of aortic cross clamp time (min) | 47 ± 19 | 48 ± 20 |
0.818
|
Postoperative risk factors | |||
Erythrocyte transfusion day 0 (%) | 118/244 (32.6 %) | 36/105 (25.5 %) |
0.123
|
Erythrocyte transfusion day 1 (%) | 61/301 (16.9 %) | 20/121 (14.2 %) |
0.465
|
Erythrocyte transfusion day 2 (%) | 66/296 (18.2 %) | 13/128 (9.2 %) |
0.013 (*)
|
Mean blood glucose concentration day 0 (mmol/L) | 7.7 ± 1.3 | 8.2 ± 1.7 |
0.000 (***)
|
Mean blood glucose concentration day 1 (mmol/L) | 8.2 ± 1.6 | 8.3 ± 1.8 |
0.408
|
Mean blood glucose concentration day 2 (mmol/L) | 9.0 ± 2.3 | 8.9 ± 2.3 |
0.634
|
Effect of the hygienic intervention of the frequency of SWI
2006–2010 to week 26 n = 362 | 2010 from week 27–2012 n = 141 | |||||
---|---|---|---|---|---|---|
Patients without infection (n = 318) 87.8 % | Patients with infections (n = 44) 12.2 % |
p-value | Patients without infection (n = 137) 97.2 % | Patients with infections (n = 4) 2.8 % |
p-value | |
Patient related riskfactors | ||||||
Age (years) | 67 ± 9 | 65 ± 10 |
0.198
| 68 ± 9 | 56 ± 7 |
0.032 (*)
|
Sex M/F | 256/62 | 33/11 |
0.394
| 118/19 | 3/1 |
0.529
|
Body mass index (kg/m2) | 28 ± 4 | 27.1 ± 4 |
0.606
| 28 ± 4 | 32 ± 4 |
0.051
|
Preoperative insulin-like growth factor 1 (mmol/mol) | 46 ± 11 (n = 307) | 52 ± 18 (n = 42) |
0.115
| 44 ± 11 (n = 131) | 44 ± 8 |
0.917
|
Diabetes (%) | 75/318 (23.6 %) | 19/44 43.2 % |
0.005 (*)
| 44/137 (32.1 %) | 1/4 (25 %) |
0.763
|
Preoperative hemoglobin concentrations (g/L) | 141 ± 14 (n = 315) | 137 ± 11 (n = 43) |
0.115
| 141 ± 14 (n = 136) | 136 ± 11 |
0.467
|
Preoperative serum creatinine concentrations (μg/L) | 86 ± 22 (n = 243) | 86 ± 23 (n = 43) |
0.908
| 87 ± 39 | 70 ± 11 |
0.094
|
Chronic obstructive pulmonary disease (%) | 11/318 (3.5 %) | 1/44 (2.3 %) |
0.680
| 1/137 (0.7 %) | 0/4 |
0.864
|
Corticoid steroid treatment (%) | 5/318 (1.6 %) | 1/44 (2.3 %) |
0.733
| 7/137 (5.1 %) | 1/4 (25 %) |
0.090
|
Current smoking/smoked the last 2 months/never smoked | 39/211 /68 | 7/35/2 |
0.029 (*)
| 15/103/19 | 0/1/3 |
0.004 (**)
|
Ejection fraction (%) | 47 ± 10 (n = 217) | 49 ± 11 (n = 31) |
0.222
| 49 ± 8 (n = 131) | 51 ± 7 |
0.481
|
Intra-operative risk factors | ||||||
Number of saphenous vein grafts (n) | 3 ± 1 (n = 317) | 3 ± 1 |
0.893
| 3 ± 1 (107) | 4 ± 1 |
0.117
|
Internal mammary artery 0/1/2 | 28/288/2 | 2/42/0 |
0.675
| 13/124/0 | 0/4/0 |
0.518
|
Duration of cardiopulmonary by-pass time (min) | 84 ± 2 (n = 317) | 84 ± 28 |
0.886
| 85 ± 29 (n = 136) | 90 ± 6 |
0.748
|
Duration of aortic cross clamp time (min) | 47 ± 18 (n = 317) | 48 ± 19 |
0.929
| 48 ± 20 (n = 136) | 53 ± 6 |
0.582
|
Postoperative risk factors | ||||||
Erythrocyte transfusion day 0 (%) | 100/318 (31.4 %) | 18/44 (40.9 %) |
0.209
| 35/137 (25.5 %) | 1/4 (25 %) |
0.980
|
Erythrocyte transfusion day 1 (%) | 52/318 (16.4 %) | 9/44 (20.5 %) |
0.496
| 19/137 (13.9 %) | 1/4 (25 %) |
0.529
|
Erythrocyte transfusion day 2 (%) | 53/318 (16.7 %) | 13/44 (29.5 %) |
0.038 (*)
| 12/137 (8.8 %) | 1/4 (25 %) |
0.268
|
Mean blood glucose concentration day 0 (mmol/L) | 7.5 ± 1.1 (n = 317) | 7.5 ± 1.0 |
0.916
| 8.2 ± 1.7 (n = 136) | 7.6 ± 0.4 |
0.585
|
Mean blood glucose concentration day 1 (mmol/L) | 8.1 ± 1.4 (n = 316) | 8.5 ± 1.9 |
0.504
| 8.3 ± 1.8 | 8.1 ± 0.9 |
0.821
|
Mean blood glucose concentration day 2 (mmol/L) | 9.0 ± 2.1 (n = 267) | 9.4 ± 3.1 (n = 42) |
0.902
| 8.9 ± 2.4 (n = 113) | 9.1 ± 1.9 |
0.887
|